Seifer DB, Wang SF, Frankfurter D. Cumulative live birth rates with autologous oocytes plateau with fewer number of cycles for each year of age > 42.
Reprod Biol Endocrinol 2023;
21:94. [PMID:
37872609 PMCID:
PMC10591412 DOI:
10.1186/s12958-023-01144-z]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE
To disaggregate the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) age category of " > 42" and compare age-stratified cumulative live birth rates (CLBR) > 42 years old.
DESIGN
Retrospective cohort study of autologous linked ART cycles.
SETTING
United States (US) National ART Database.
PATIENT(S)
Women > 42 years old without a history of prior ART cycles who underwent ART between 2014-2020 as reported to the SART CORS database.
INTERVENTION(S)
Disaggregate the SART CORS age category of " > 42" into age-stratified cumulative live birth rates (CLBR).
MAIN OUTCOME MEASURE(S)
Age-stratified cumulative live birth rates (CLBR) for women ≥ 43 years old.
RESULTS
Between 2014-2020, 24,650 women > 42 years old without history of prior ART underwent 58,132 cycles, resulting in 1,982 live births. Women ages 43, 44, 45, 46, 47, 48, 49, ≥ 50 achieved maximal CLBR of 9.7%, 8.6%, 5.0%, 3.6%, 2.5%, 1.5%, 2.7%, 1.3%, respectively. CLBR for women between 43-45 were significantly higher compared to those 46 and older (p < 0.05). Among women 46 and older, CLBR were not significantly different. Women ages 43 and 44 did not exhibit a significant increase in CLBR beyond the 5th cycle. Age 45 and 46 reached CLBR plateau by the 3rd cycle. Age ≥ 47 CLBR plateaued after the first cycle. After adjusting for age, race/ethnicity, BMI, nulliparity, etiology of infertility, number of oocytes retrieved, embryos transferred, blastocyst transfer, use of ICSI, PGT, and ART treatment cycle number, there was no association between markers of ovarian reserve (day 3 FSH and random AMH levels) and live birth for women > 42.
CONCLUSIONS
While CLBR of autologous cycles from women 42 or younger generally plateau by cycle number 5, age-stratified cycles from women > 42 plateau after fewer cycles to maximize CLBR. Patient and physician expectations for maximum CLBR beyond 42 may be practically based on fewer planned cycles before reaching an age-specific CLBR plateau than may have been previously expected.
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